First, the sad statistics: Worldwide, suicide is the second-leading cause of death among young people ages 15 to 19. In the United States, according to the CDC, suicide was the third-leading cause of death in 2009 for people ages 10-14, 15-19 and 20-24. It was the second-leading cause of death for people ages 25 to 34.
The vast majority of people who commit suicide have a mental illness. But for nearly a decade doctors and researchers have been debating whether certain classes of medications used to treat mental illness increase or decrease the risk of suicide – as well as suicidal thoughts and behaviors – in young people.

In 2004, the FDA placed a black-box warning on all antidepressants, warning that they increase the risk of suicidal thinking and behavior (called “suicidality”) in children and teens.

An FDA analysis had found that one type of antidepressants in particular, the SSRIs, which include Prozac, Zoloft, Paxil, Lexapro and others, doubled the risk of suicidality in young people from 2% to 4%. But it found no completed suicides in the studies it looked at, which included some 2,200 children.

In 2005, the European medications regulatory authority urged European countries to put strong warnings about using either SSRI antidepressants, or SNRI antidepressants, such as Effexor and Cymbalta, for children or teens. The warning was based on the drugs’ potential to induce suicidality and hostile or aggressive behavior.

Also in 2005, the UK’s National Health Service issued guidelines urging doctors to avoid prescribing antidepressants to kids under 18 unless other therapies for depression didn’t work.

After the U.S. and European warnings went into effect, prescribing of antidepressants to children and teens decreased. At the same time, some …

People who take psychiatric medications long-term are no strangers to stigma, or the threat of it. We perennially face, for example, the question of whether it’s worth risking others’ judgment and the potential negative repercussions of disclosing our conditions — and the fact that we take medication for them.

But you can commit to taking medications long-term and still perpetuate or further the stigma associated with meds. And I don’t just mean that in the sense of keeping your medication regimen secret. Most of us do so in another way altogether that we’re largely unaware of.

The fact is, most people have some kind of internal barometer when it comes to medications – which ones they are willing to take, and which ones they’re not.

This weekend a mother published a New York Timescolumn about how her son came to be diagnosed with ADHD and became a member of the ballooning “Ritalin Generation.”

“Just a little medication,” the teacher told the boy’s mother, “could really turn things around” for the boy, who was having trouble focusing on class worksheets and lining up quietly for transitions between classes.

When the mother firmly responded that she and her husband weren’t going to medicate their son, the teacher backtracked, sounding mock-horrified.

She wasn’t explicitly suggesting medication, she said. The law prohibited such a thing. She just didn’t want him to fall through the cracks – and thus was was merely suggesting the boy’s parents have him evaluated by a psychologist.

The boy was evaluated, and sure enough, he ended up on Ritalin for a short-time, though he quit it on his own a year later, matured out of his former inattentiveness, and eventually ended up a well-adjusted, school-loving honor-roll student – and medication-free.

Such stories are commonly invoked as cautionary tales about the alleged over-diagnosis of ADHD and other behavior disorders and over-prescribing of drugs like Ritalin to keep children’s behavior in check. Teachers recommending meds for disruptive students often feature prominently. In fact, the debate over school involvement in medicating disruptive children showed up as early as the early 1970s.

Psychiatric medications have a lot of potential hidden costs.

We don’t know, for example, how taking them from a young age affects long-term brain and psychological development in kids. They have myriad of side effects, some serious, like diabetes, high cholesterol, neurological impairment and birth defects when taken in pregnancy. They carry stigma, both from others and self-imposed.

But I’m not talking metaphorically about costs here. I’m talking straight-up financial outlays. Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs.

One big reason is the so-called “medication merry-go-round.”

For years, researchers and health policy experts have been charging that psychiatric medications aren’t adequately tested in children – and a new study gives some powerful ammunition to that critique.

The study, from Pediatrics, looked at clinical drug trials between 2006 and 2011, involving five conditions that cause the greatest “disease burden” for children, as measured by a rating that counts the total years of healthy life lost to disability.

In high-income countries like the United States, three of the five conditions with the highest disease burden among kids were psychiatric disorders: depression, bipolar disorder and schizophrenia.

But of the drug studies to treat those conditions, disproportionately few involved children.

The lack of trials is troubling because children and adults don’t necessarily respond to medication in the same way. With psychiatric drugs, that’s a potential problem both for physical reasons – and for psychological and developmental ones.

New York, like much of the country, was mired in a massive heat wave for much of this week. Everyone was complaining that they could hardly stand to go outside – the heat index was 100 degrees. Once high temperatures set in, I began feeling particularly faint and achy, like I was getting sick.

At first, I figured I was about to get a migraine, since I often feel like this before a particularly bad one. But no big headache arrived. Then I figured I was getting the flu. But I didn’t have other symptoms, like a sore throat or an upset stomach.

And then, I read an article online from the Philadelphia Inquirer about how heat and certain medications affect how well the body can regulate its own temperature, making people who take them more susceptible to extreme heat.

I knew that people who take lithium as a mood stabilizer have to be careful in the heat. The drug has has a narrow therapeutic range and can reach toxic levels in your system if you get dehydrated, something that’s much more likely to happen in hot weather.

But it was news to me that other psychiatric drugs, including the antidepressants I take, could alter the body’s ability to regulate its temperature.

In recent years, there has been a huge increase in the prescribing of psychiatric medication to treat aggression in children.

Specifically, atypical antipsychotic and mood stabilizing drugs, originally developed for schizophrenia and bipolar disorder in adults, are now routinely prescribed to treat the aggression that occurs in a variety of childhood psychiatric disorders.

Prescriptions for atypical antipsychotics increased sixfold between 1993 and 2002, and the majority were prescribed to treat non-psychotic aggression, according to a task force that recently published guidelines on how to treat aggression in kids.

At the same time, we’re in the midst of a collective national hand-wringing over how to reduce childhood bullying. Might drugs that curb aggression be the answer?

On this blog and in my new book, Dosed: The Medication Generation Grows Up, I explore young people’s experiences with medication. And oftentimes, by exposing their ambivalence, even their resentment, toward their treatment from an early age, I end up implicitly questioning the value of early intervention for mental illness.